SUMMARY The prevalence of oral candidosis and the frequency of isolation of Candida albicans and its density and distribution have been determined in the mouths of 50 patients with diabetes mellitus and 50 healthy volunteers matched for age, sex, dental status and smoking habits. Three of the diabetic patients were found to have a chronic oral candidosis. According to an imprint culture technique, the oral carrier rate and density of C albicans were both higher in the diabetic group as a whole than in the control subjects. Smoking was associated with an increased prevalence of the yeast in diabetes mellitus. Diabetics wearing dentures had higher candidal density than those without a prosthesis. No differences in candidal status could be detected according to the degree of control of diabetes, mode of treatment, duration of diabetes or the patient's age. Local factors such as smoking and the presence of dentures, particularly when worn continuously, interact with diabetes mellitus in promoting candidal colonisation of the mouth. Attention to these predisposing factors could reduce the incidence of thrush in diabetics.Although Winner and Hurley' state that patients with diabetes mellitus are susceptible to thrush, no clinical survey of diabetics to establish the incidence of candidal infection in the mouth has been done. Moreover, previous accounts do not agree as to whether Candida albicans iS23 or is not45 more prevalent in the mouths of diabetics than in nondiabetics. These conflicting reports may reflect the fact that local factors such as denture wearing and smoking which significantly influence oral candidal populations6 7 were not considered by most previous investigators. The method of sampling also seems important. Earlier workers sampled only saliva34 but if many oral sites are investigated using imprint cultures, C albicans can be isolated only from the tongue in as many as one-third of dentate carriers.7 Accordingto Oddset al.,8the degree of control of the diabetes significantly influenced the extent of oral yeast colonisation but again local factors were ignored.Our study describes the prevalence of candidal infection in the mouths of diabetic patients. With the imprint culture technique, the frequency of isolation of Calbicans and its intraoral density and distribution were assessed in the diabetic patients and age-and

An imprint culture technique has been employed to study the prevalence and intraoral distribution of Candida albicans in 16 patients with Sjögren's syndrome and in 16 healthy controls matched for age, sex, and dental status. The prevalence and intraoral density of C. albicans was found to be significantly higher at almost all sites in the Sjögren's patients than in the controls. The distribution of candida was also altered, being significantly higher in the floor of the mouth and anterior labial sulcus in the Sjögren's group. There was an approximate inverse relationship between candida populations and rate of salivary flow. Mean candida densities were found to be significantly higher in those Sjögren's patients with detectable serum rheumatoid factor in the serum. However, patients with primary Sjögren's syndrome had significantly higher mean candida densities compared with patients with secondary Sjögren's syndrome.

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A survey of specimens submitted to five English laboratories2 showed that the most important contribution of the results to patient management was that they helped to exclude particular possible diagnoses. Urine examinations are a substantial proportion of the work of any microbiology laboratory, and it is clearly unacceptable that the reports on up to 20% of such specimens may be misleading. With the help and encouragement of our clinical colleagues we are reviewing both the rationale and the cost effectiveness of microbiological investigation generally. While the major areas of concern are "routine" screening tests, duplicated specimens on the same patient, and out-ofhours requests, substantial savings in time, money, and temper can clearly be made by avoiding self-inflicted clinical confusion like that described here. Reports on other specimens too may be misleading but faults are not generally as easily demonstrable as in urine.